Impact of Cocaine Use Disorder History on Receipt of Guideline-indicated Medications and Therapies Following ST-elevated Myocardial Infarction

Objectives: – Following ST-elevation myocardial infarction (STEMI), there are standard guideline-indicated therapies including revascularization (percutaneous coronary intervention or coronary artery bypass surgery), medications (aspirin, angiotensin converting enzyme [ACE] inhibitors and angiotensin receptor blockers [ARBs], beta-blockers, high-intensity statins, P2Y12 inhibitors], and outpatient rehabilitation (cardiac rehabilitation [CR]). Those with substance use disorder (SUD), including cocaine use disorder (CUD), have been shown to be less likely to receive certain medical treatments, but the effect of SUD history on receipt of post-STEMI therapies is not well known. Methods: – The TriNetX Research database was used to identify adults aged 18 years or older hospitalized with STEMI between 2014 and 2024. Patients were divided into two groups: those with and without a history of CUD. After 1:1 propensity score matching for demographic, psychosocial, and medical characteristics, differences in receipt of guideline-indicated therapies by CUD history were examined. Results: – After propensity matching, 1366 patients were identified in each group. Those with a history of CUD were more likely to be prescribed ACE/ARBs [OR: 1.22, 95% CI: 1.05–1.41] or statins [OR: 1.19, 95% CI: 1.03–1.39], less likely to receive revascularization [OR: 0.69, 95% CI: 0.51–0.94] and much less likely to attend CR [OR: 0.41, 95% CI: 0.28–0.61] as compared with those without. No differences were seen by group in prescription of other medications. Conclusions: – History of CUD was associated with modest effects on receipt of prescriptions post-STEMI. However, revascularization and attendance at CR were much lower in those with CUD. There is a need for more targeted, individualized, and supportive treatment plans in patients with CUD who present with STEMI.